Intraductal papillary-mucinous tumors of the pancreas: Clinicopathologic features, outcome, and nomenclature. Members of the Pancreas Clinic, and Pancreatic Surgeons of Mayo Clinic

BACKGROUND & AIMS: Intraductal papillary-mucinous tumor (IPMT) of the pancreatic ducts is increasingly recognized. This study investigated if clinical, imaging, or, histological features predicated outcome, formulated a treatment algorithm, and clarified relationships among IPMT, mucinous cystic neoplasms of the pancreas (MCN), and chronic pancreatitis. METHODS: The medical records, radiographs, and pathological specimens of 15 patients with IPMT (dilated main pancreatic duct or branch ducts with mucin overproduction) who were evaluated between October 1983 and January 1994 were reviewed. RESULTS: One patient had hepatic metastases. Fourteen underwent an operation (6 distal pancreatectomy, 4 total pancreatectomy, and 4 pancreaticoduodenectomy); all had dysplastic intraductal epithelium and chronic pancreatitis, whereas 3 had invasive adenocarcinoma. After a median of 25 months, 10 patients were alive; 3 of 4 with malignant and 2 of 11 with benign IPMT died (P < 0.05). Patients with or without carcinoma had similar clinical and radiographic features. A clinical diagnosis of chronic pancreatitis had been made in 9 patients with benign IMPT and in none with malignant IPMT (P < 0.05). CONCLUSIONS: IPMT is a dysplastic and likely precancerous lesion that is frequently diagnosed as chronic pancreatitis and is separate from MCN. Because it is not possible to distinguish noninvasive from invasive IPMT preoperatively, complete surgical excision of the dysplastic process is our treatment of choice whenever appropriate. (Gastroenterology 1996 Jun;110(6):1909-18)     

Human platelet-derived mitogens. I. Identification of insulinlike growth factors I and II by purification and N alpha amino acid sequence analysis

Human platelet lysates contained potent mitogenic activities for MCF-7 human breast-cancer cells in serum-free-defined media. Because these activities were not replaced by known platelet mitogens, such as platelet-derived growth factor or transforming growth factor beta, we sought to identify the breast cancer cell mitogens by purification and N alpha amino-acid sequencing. Acetic acid extracts of outdated human platelets were concentrated by ammonium sulfate precipitation and fractionated on Sephadex G-50 and Bio-Gel P-10 columns in 0.5 mol/L acetic acid. Two major activities were resolved by molecular sieve methods and fractionated further by reverse-phase high-performance liquid chromatography (HPLC). Purifications (70,000 to 870,000-fold) were accomplished yielding mol wt 7,400 products that were homogeneous as determined by iodination, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and autoradiography. The factors were identified as insulinlike growth factor I (IGF-I) and II (IGF-II) and truncated IGF-I by N alpha amino acid microsequencing. In dose-response experiments, platelet-derived IGF-I and IGF-II promoted multiple divisions of the MCF-7 cells with ED50 values of 12 and 100 pg/mL, respectively. The specific activities and other bioassay characteristics of platelet-derived IGF-I and IGF-II were similar to those of recombinant-produced human growth factors. This is the first report of the purification of insulinlike growth factors from human platelet lysates.     

Evaluation and comparison of anti-inflammatory properties of ibuprofen using two drug delivery systems after third molar surgery: using chitosan microspheres as a carrier for local drug delivery in to the third molar socket and through the oral route

We undertook this study to assess the analgesic and anti-inflammatory properties of ibuprofen when administered through two drug delivery systems after mandibular third molar surgery. The study was conducted on 100 patients who required the surgical removal of impacted mandibular third molars under local anaesthesia. The study subjects were divided into two groups of 50 patients each. Patients in the study group were given ibuprofen-incorporated chitosan-based microspheres, which were packed into the third molar sockets after removal of impacted teeth. Patients in the control group were prescribed with ibuprofen 400mg tablets that were to be administered orally after the removal of impacted mandibular third molars. All patients were assessed for pain, swelling, and trismus on the second, fourth, and seventh postoperative days, and wound healing was assessed on the seventh postoperative day. Patients in the study group had significantly less pain and comparatively better mouth opening on the second, fourth, and seventh postoperative days, which showed clinically and statistically significant results of p<0.05, respectively, while the assessment of swelling for the study group did not show statistically significant results on any of the three postoperative days. Among 50 patients in the study group, two had wound gaping, and among 50 patients in the control group, four presented with wound gaping and three patients developed dry socket. Ibuprofen-incorporated chitosan-based microspheres (study group) had comparatively better analgesic and anti-inflammatory properties with drastic reduction of pain, swelling, trismus, and also had a reliable wound healing property when compared with the orally-administered ibuprofen (control group) after mandibular third molar surgery.     

Feasibility of high-resolution, intravascular ultrasonic imaging catheters

A small-aperture, prototype ultrasonic imaging system, typical of the size necessary to be embedded in a catheter, was developed to evaluate the feasibility of intravascular ultrasonic imaging catheters (UICs). The evaluation included in vitro imaging of postmortem samples of human femoral and iliac arteries with the UIC prototype and a high-resolution magnetic resonance (MR) proton imager. Excellent correlations between results from the UIC images, MR images, and tissue specimens were demonstrated. Although the current prototype is too large to be useful in examination of smaller vessels such as coronary arteries, the signal-to-noise ratio and resolution obtained indicate that imaging with intravascular UICs is feasible and may have significant diagnostic value.     

Glomus jugulare tumours in South Wales — A twenty-year review

Fourteen patients with glomus jugulare tumours presenting over the last 20 years in South Wales are reviewed. All were treated with radiotherapy and only two died, both of whom had radiological evidence of extensive intrapetrosal spread. All the remainder had good relief of symptoms and are at present free from evidence of progressing tumour.     

Assessment of the functioning of peripheral auditory pathways after cochlear re-implantation in young children using intra-operative objective measures

The intra-operative electrical auditory brainstem response (EABR), electrical stapedius reflex threshold (ESRT) and the early post-operative behavioural threshold level (T-level) were recorded in five children undergoing cochlear re-implantation. The aim of the study was to assess objectively the effect of re-implantation on intra-operative objective measures and to investigate neuronal function. The children were aged between 2.06 years and 4.5 years at first implantation. Following failure of the first device, re-implantation was carried out 1.42-5.52 years later. Characteristics of the EABR and ESRT across the electrode array were typical of the expected pattern of responses on both occasions. In particular, the slopes of the amplitude input/output (I/O) functions for wave eV of the intraoperative EABR were similar for both the first and second implants even though absolute thresholds were generally elevated after re-implantation. This elevation in intra-operative threshold was more pronounced than the change in early post-operative behavioural threshold level for electrical stimulation (T-level). Our findings confirm a high level of neuronal survival after re-implantation. Threshold of the intra-operative EABR at the time of re-implantation greatly underestimates the sensitivity of the subsequent early post-operative T-levels.